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Zhang Y, Xu Y, Cao Z, Zhang Y, Yang Y, Li J, Ding X, Hu F, Ma J. Analysis of the factors influencing of sleep quality in intensive care unit awake patients based on a structural equation model: A cross-sectional study. J Clin Nurs 2024. [PMID: 38797951 DOI: 10.1111/jocn.17311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The objective of this study was to construct and validate a structural equation model (SEM) to identify factors associated with sleep quality in awake patients in the intensive care unit (ICU) and to assist in the development of clinical intervention strategies. RESEARCH METHODS/SETTING In this cross-sectional study, 200 awake patients who were cared for in the ICU of a tertiary hospital in China were surveyed via several self-report questionnaires and wearable actigraphy sleep monitoring devices. Based on the collected data, structural equation modelling analysis was performed using SPSS and AMOS statistical analysis software. The study is reported using the STROBE checklist. RESULTS The fit indices of the SEM were acceptable: χ2/df = 1.676 (p < .001) and RMSEA = .058 (p < 0.080). Anxiety/depression had a direct negative effect on the sleep quality of awake patients cared for in the ICU (β = -.440, p < .001). In addition, disease-freeness progress had an indirect negative effect on the sleep quality of awake patients cared for in the ICU (β = -.142, p < .001). Analgesics had an indirect negative effect on the sleep quality of awake patients cared for in the ICU through pain and sedatives (β = -.082, p < .001). Sedation had a direct positive effect on the sleep quality of conscious patients cared for in the ICU (β = .493; p < .001). CONCLUSION The results of the SEM showed that the sleep quality of awake patients cared for in the ICU is mainly affected by psychological and disease-related factors, especially anxiety, depression and pain, so we can improve the sleep quality of patients through psychological intervention and drug intervention.
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Affiliation(s)
- Yanting Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Ying Xu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Zheng Cao
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Yuan Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Yihua Yang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Jin Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Xinbo Ding
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, China
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Jaschke AC, Bos AF. Concept and considerations of a medical device: the active noise cancelling incubator. Front Pediatr 2023; 11:1187815. [PMID: 37465419 PMCID: PMC10350684 DOI: 10.3389/fped.2023.1187815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Background An increasingly 24/7 connected and urbanised world has created a silent pandemic of noise-induced hearing loss. Ensuring survival to children born (extremely) preterm is crucial. The incubator is a closed medical device, modifying the internal climate, and thus providing an environment for the child, as safe, warm, and comfortable as possible. While sound outside the incubator is managed and has decreased over the years, managing the noise inside the incubator is still a challenge. Method Using active noise cancelling in an incubator will eliminate unwanted sounds (i.e., from the respirator and heating) inside the incubator, and by adding sophisticated algorithms, normal human speech, neonatal intensive care unit music-based therapeutic interventions, and natural sounds will be sustained for the child in the pod. Applying different methods such as active noise cancelling, motion capture, sonological engineering. and sophisticated machine learning algorithms will be implemented in the development of the incubator. Projected Results A controlled and active sound environment in and around the incubator can in turn promote the wellbeing, neural development, and speech development of the child and minimise distress caused by unwanted noises. While developing the hardware and software pose individual challenges, it is about the system design and aspects contributing to it. On the one hand, it is crucial to measure the auditory range and frequencies in the incubator, as well as the predictable sounds that will have to be played back into the environment. On the other, there are many technical issues that have to be addressed when it comes to algorithms, datasets, delay, microphone technology, transducers, convergence, tracking, impulse control and noise rejection, noise mitigation stability, detection, polarity, and performance. Conclusion Solving a complex problem like this, however, requires a de-disciplinary approach, where each discipline will realise its own shortcomings and boundaries, and in turn will allow for innovations and new avenues. Technical developments used for building the active noise cancellation-incubator have the potential to contribute to improved care solutions for patients, both infants and adults.Code available at: 10.3389/fped.2023.1187815.
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Affiliation(s)
- Artur C. Jaschke
- Department of Paediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Music Therapy, ArtEZ University of the Arts, Enschede, Netherlands
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, United Kingdom
| | - Arend F. Bos
- Department of Paediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Cash EK, Giambra BK. Audiovisual Recording in the Inpatient Setting: A Method for Studying Parent-Nurse Communication. JOURNAL OF FAMILY NURSING 2023; 29:192-201. [PMID: 37133301 DOI: 10.1177/10748407231162131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Audiovisual recordings are under-utilized for capturing interactions in inpatient settings. Standardized procedures and methods improve observation and conclusion validity drawn from audiovisual data. This article provides specific approaches for collecting, standardizing, and maintaining audiovisual data based on a study of parent-nurse communication and child and family outcomes. Data were collected using audio and video recorders at defined time points simplifying its collection. Data were downloaded, edited for size and privacy, and securely stored, then transcribed, and subsequently reviewed to ensure accuracy. Positive working relationships with families and nurses facilitated successful study recruitment, data collection, and transcript cleaning. Barriers to recruitment and data collection, such as privacy concerns and technical issues, were successfully overcome. When carefully coordinated and obtained, audiovisual recordings are a rich source of research data. Thoughtful protocol design for the successful capture, storage, and use of recordings enables researchers to take quick action to preserve data integrity when unexpected situations arise.
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Affiliation(s)
- Erin K Cash
- Cincinnati Children's Hospital Medical Center, OH, USA
| | - Barbara K Giambra
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Nursing, OH, USA
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Ruettgers N, Naef AC, Rossier M, Knobel SEJ, Jeitziner MM, Grosse Holtforth M, Zante B, Schefold JC, Nef T, Gerber SM. Perceived sounds and their reported level of disturbance in intensive care units: A multinational survey among healthcare professionals. PLoS One 2022; 17:e0279603. [PMID: 36584079 PMCID: PMC9803129 DOI: 10.1371/journal.pone.0279603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The noise levels in intensive care units have been repeatedly reported to exceed the recommended guidelines and yield negative health outcomes among healthcare professionals. However, it is unclear which sound sources within this environment are perceived as disturbing. Therefore, this study aimed to evaluate how healthcare professionals in Germany, Switzerland, and Austria perceive the sound levels and the associated sound sources within their work environment and explore sound reduction strategies. MATERIAL AND METHODS An online survey was conducted among 350 healthcare professionals working in intensive care units. The survey consisted of items on demographic and hospital data and questions about the perception of the sound levels [1 (strongly disagree) to 5 (strongly agree)], disturbance from sound sources [1 (not disturbing at all) to 5 (very disturbing)], and implementation potential, feasibility, and motivation to reduce sound reduction measures [1 (not high at all) to 5 (very high)]. RESULTS Approximately 69.3% of the healthcare professionals perceived the sound levels in the ICUs as too high. Short-lasting human sounds (e.g. moans or laughs) [mean (M) ± standard deviation (SD) = 3.30 ± 0.81], devices and alarms (M ± SD = 2.67 ± 0.59), and short-lasting object sounds (M ± SD = 2.55 ± 0.68) were perceived as the most disturbing sounds. Reducing medical equipment alarms was considered to have greater implementation potential [M ± SD = 3.62 ± 0.92, t(334) = -7.30, p < 0.001], feasibility [M ± SD = 3.19 ± 0.93, t(334) = -11.02, p < 0.001], and motivation [M ± SD = 3.85 ± 0.89, t(334) = -10.10, p < 0.001] for reducing the sound levels. CONCLUSION This study showed that healthcare professionals perceive short-lasting human sounds as most disturbing and rated reducing medical equipment alarms as the best approach to reduce the sound levels in terms of potential, feasibility, and motivation for implementation.
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Affiliation(s)
- Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marilyne Rossier
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Martin Grosse Holtforth
- Psychosomatic Medicine, Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- * E-mail:
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Zhang Z, Liu J, Wu X, Yan J. What are the sleep characteristics among early kidney transplant recipients? An objective and subjective measurement from China. PLoS One 2022; 17:e0277678. [PMID: 36413558 PMCID: PMC9681072 DOI: 10.1371/journal.pone.0277678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the sleep quality by self-reported questionnaires and polysomnography (PSG) among early kidney transplant recipients (KTRs) and to further explore their correlation. DESIGN This was a prospective and cross-sectional analysis of the sleep characteristics among early kidney transplant recipients through an objective and subjective measurement. PARTICIPANTS Patients with end stage renal disease on the transplant waiting list and after kidney transplantation were from a major organ transplantation center in Southern China (n = 83). PRIMARY AND SECONDARY OUTCOME MEASUREMENTS Objective outcomes: PSG, noise and light. Subjective outcomes: demographic and clinical questionnaires, self-reported pain and Richards Campbell sleep questionnaire (RCSQ). After agreement with the informed consent, participants first completed demographic and clinical questionnaires, then worn the PSG within 5-10 days after kidney transplantation. Both noise, light and self-reported pain were monitored during sleep. After completion of PSG, the RCSQs were filled out next morning. RESULTS A total of 298 patients were recruited and 83 participants were finally analyzed. The total RCSQ mean score was 51.0±18.9mm. The prevalence of poor sleep quality among early KTRs was 45.1%. Most of PSG characteristics were significantly correlated with their corresponding RCSQ items. And the total RCSQ scores were significantly correlated with the number of awakenings, the N2 percentage and the total sleep time (r = 0.79, 0.47 and 0.40, P<0.05) respectively. Noise was a statistically significant factor affecting the subjective sleep quality. CONCLUSIONS The sleep quality in early KTRs measured by both PSG and RCSQ exhibits consistency with each other. Sleep disruption always remains a substantial problem and is affected by self-reported noise among early KTRs. The RCSQ is easily applicable and interpretable so that it can be used for future daily clinical practice.
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Affiliation(s)
- Zhihao Zhang
- School of Public Administration, Central South University, Changsha, Hunan, China
| | - Jia Liu
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
- Transplantation Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - XiaoXia Wu
- Department of Nursing, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
- * E-mail: (JY); (XW)
| | - Jin Yan
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
- Department of Nursing, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
- * E-mail: (JY); (XW)
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Lu MJ, Chen WY, Li DJ. Efficacy of music therapy and predictors of sleep disturbance among patients with chronic schizophrenia: A prospective study. Arch Psychiatr Nurs 2022; 40:1-7. [PMID: 36064231 DOI: 10.1016/j.apnu.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/04/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVES Patients with schizophrenia often suffer from sleep disturbance. Music therapy, as a non-invasive intervention, may have benefit on sleep problem in such population. Our study aimed to investigate the efficacy of music therapy on sleep disturbance among patients with schizophrenia. METHOD This prospective study recruited participants with schizophrenia along with sleep disturbances in the chronic wards. Patients in the control group received standard care, and those in the intervention group received additional music therapy before sleeping at night for four weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the severity of sleep disturbance. The generalized estimating equation (GEE) was used to analyze measure the difference of change in PSQI scores between both groups at the baseline and four weeks later. It was also applied to find the predictors of treatment efficacy within intervention group. FINDINGS A total of 66 (31 in control group and 35 in intervention group) participants were recruited. After adjusting with the demographic variables, the change of PSQI among intervention group was significantly more than the change among control group (Group × time; Estimate = -7.05, p < 0.001), indicating the efficacy of music therapy. In addition, irreligious patients and those with chronic medical disease predicted better efficacy. Whereas, elderly patients had compromising efficacy of music therapy. CONCLUSION Music therapy demonstrated its merit on sleep disturbance among patients with schizophrenia. Whereas, healthcare workers should consider the variability of severity in schizophrenia during clinical practice.
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Affiliation(s)
- Mei-Jou Lu
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City 82144, Taiwan; Department of Nursing, School of Nursing, Fooyin University, Kaohsiung City 83102, Taiwan
| | - Wan-Yi Chen
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City 82144, Taiwan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City 802211, Taiwan; Department of Nursing, Meiho University, Pingtung Country 91202, Taiwan.
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Kooshanfar Z, Ashrafi S, Paryad E, Salmanghasem Y, Khaleghdoost Mohammadi T, Kazemnezhad Leili E, Mohammad Javad Golhosseini S. Sources of noise and their effects on nurses in intensive care units: A cross sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Nilius G, Richter M, Schroeder M. Updated Perspectives on the Management of Sleep Disorders in the Intensive Care Unit. Nat Sci Sleep 2021; 13:751-762. [PMID: 34135650 PMCID: PMC8200142 DOI: 10.2147/nss.s284846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
Sleep disorders and circadian dysrhythmias are extremely prevalent in critically ill patients. Impaired sleep has a variety of etiologies, exhibits a wide range of negative effects and, moreover, might deteriorate the patient's prognosis. Despite a number of scientific findings and increased awareness, the importance of sleep optimization is still lower on the list of priories in the intensive care unit (ICU). The techniques of measuring and the evaluation of sleep quantity and quality are a great challenge in the ICU setting. The subjective and objective tools of sleep validation continue to suffer from deficiencies. Treatment approaches to improve the critically ill patient's sleep have focused on non-pharmacologic and pharmacologic strategies with some promising results. But pharmacological interventions alone could not provide sufficient patient benefit. Being aware and knowing of sleep problems and the beneficial effect of the necessary therapies in ICU patients requires greater acceptance. The application of available methods and the development of new methods to prevent sleep disorders in the ICU offer the potential to improve the critically ill patient's outcome.
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Affiliation(s)
- Georg Nilius
- Kliniken Essen Mitte, Department of Pneumology, Essen, Germany
- Witten/Herdecke University, Department of Internal Medicine, Witten, Germany
| | | | - Maik Schroeder
- Kliniken Essen Mitte, Department of Pneumology, Essen, Germany
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Hasegawa Y, Ryherd E. Clustering acoustical measurement data in pediatric hospital units. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 148:265. [PMID: 32752740 DOI: 10.1121/10.0001584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
The previous hospital acoustic literature has highlighted some important considerations and various complexities regarding objective noise measurements. However, extensive use of conventional acoustical metrics such as logarithmically averaged equivalent sound pressure levels (Leq) do not sufficiently describe hospital acoustical environments and often lack considerations of the room-based activity status that can significantly influence the soundscape. The goal of this study was to explore utilizing statistical clustering techniques in healthcare settings with a particular aim of identifying room-activity conditions. The acoustic measurements were conducted in the patient rooms of two pediatric hospital units and subsequently classified based on two room-activity conditions-active and non-active conditions-by applying statistical clustering analyses with standard k-means and fuzzy c-means algorithms. The results of this study demonstrate the most probable noise levels and degree of associations of the measured noise levels for the two room-activity conditions. The results were further validated in terms of the clustered levels, the number of conditions, and parameter dependency. The clustering approach allows for a more thorough soundscape characterization than single-number level descriptors alone by providing a method of identifying and describing the noise levels associated with typical, intrinsic activity conditions experienced by occupants.
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Affiliation(s)
- Yoshimi Hasegawa
- Department of Architecture, School of Design and Environment, National University of Singapore, 4 Architecture Drive, Singapore, 117566
| | - Erica Ryherd
- The Durham School of Architectural Engineering and Construction, University of Nebraska-Lincoln, The Peter Kiewit Institute 107, 1110 South 67th Street, Omaha, Nebraska 68182-0816, USA
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Bertsch M, Reuter C, Czedik-Eysenberg I, Berger A, Olischar M, Bartha-Doering L, Giordano V. The "Sound of Silence" in a Neonatal Intensive Care Unit-Listening to Speech and Music Inside an Incubator. Front Psychol 2020; 11:1055. [PMID: 32528386 PMCID: PMC7264369 DOI: 10.3389/fpsyg.2020.01055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background: The intrauterine hearing experience differs from the extrauterine hearing exposure within a neonatal intensive care unit (NICU) setting. Also, the listening experience of a neonate drastically differs from that of an adult. Several studies have documented that the sound level within a NICU exceeds the recommended threshold by far, possibly related to hearing loss thereafter. The aim of this study was, first, to precisely define the dynamics of sounds within an incubator and, second, to give clinicians and caregivers an idea about what can be heard “inside the box.” Methods: Audio recordings within an incubator were conducted at the Pediatric Simulation Center of the Medical University Vienna. They contained recorded music, speech, and synthesized sounds. To understand the dynamics of sounds around and within the incubator, the following stimuli were used: broadband noise with decreasing sound level in 10 steps of 6 dB, sine waves (62.5, 125, 250, 500, 1000, 2000, 4000, 8000, and 16,000 Hz), logarithmic sweep (Chirp) over the frequency band 20 Hz to 21 kHz, singing male voice, singing, and whispering female voice. Results: Our results confirm a protective effect of the incubator from noises above 500 Hz in conditions of “no-flow” and show almost no protective effect of an incubator cover. We, furthermore, observed a strong boost of low frequencies below 125 Hz within the incubator, as well as a notable increase of higher frequency noises with open access doors, a significant resonant effect of the incubator, and a considerable masking effect of the respiratory support against any other source of noise or sound stimulation even for “low-flow” conditions. Conclusion: Our study reveals high noise levels of air supply at high flow rates and the boost of low frequencies within the incubator. Education of medical staff and family members as well as modifications of the physical environment should aim at reducing noise exposure of preterm infants in the incubator. Audiovisual material is provided as Supplementary Material.
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Affiliation(s)
- Matthias Bertsch
- Department of Music Physiology, University of Music and Performing Arts Vienna, Vienna, Austria
| | | | | | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lisa Bartha-Doering
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Pisani MA, D'Ambrosio C. Sleep and Delirium in Adults Who Are Critically Ill: A Contemporary Review. Chest 2019; 157:977-984. [PMID: 31874132 DOI: 10.1016/j.chest.2019.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 01/09/2023] Open
Abstract
Sleep is important to health and well-being, and studies in healthy adults have demonstrated that sleep deprivation impacts respiratory, immune, and cognitive function. Historically, because of the nature of critical illness, sleep has not been considered a priority for patient care in the ICU. More recently, research has demonstrated that sleep is markedly abnormal in patients who are critically ill. In addition, there is often disruption of circadian rhythms. Delirium is a syndrome of acute alteration in mental status that occurs in the setting of contributing factors such as serious illness, medication, and drug or alcohol intoxication or withdrawal. Delirium is a frequent occurrence in critical illness, and research has demonstrated several adverse outcomes associated with delirium including persistent cognitive impairment and increased mortality. Sleep deprivation and delirium share many common symptoms. The similarity in symptoms between sleep disruption and delirium have prompted experts to draw links between the two and question both the relationship and its direction. In addition, the inclusion of sleep disturbance to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition in its constellation of symptoms used in diagnosing delirium has increased awareness of the link between sleep and delirium. This paper will review the literature on sleep in critical illness and the potential mechanisms and pathways that may connect sleep and delirium.
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Wallis R, Harris E, Lee H, Davies W, Astin F. Environmental noise levels in hospital settings: A rapid review of measurement techniques and implementation in hospital settings. Noise Health 2019; 21:200-216. [PMID: 32820743 PMCID: PMC7650850 DOI: 10.4103/nah.nah_19_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 12/31/2019] [Accepted: 01/16/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Hospitals provide treatment to improve patient health and well-being but the characteristics of the care environment receive little attention. Excessive noise at night has a negative impact on in-patient health through disturbed sleep. To address this hospital staff must measure night-time environmental noise levels. Therefore, an understanding of environmental noise measurement techniques is required. In this review, we aim to 1) provide a technical overview of factors to consider when measuring environmental noise in hospital settings; 2) conduct a rapid review on the equipment and approaches used to objectively measured noise in hospitals and identify methodological limitations. DESIGN : A rapid review of original research articles, from three databases, published since 2008. Studies were included if noise levels were objectively measured in a hospital setting where patients were receiving treatment. RESULTS 1429 articles were identified with 76 included in the review. There was significant variability in the approaches used to measure environmental noise in hospitals. Only 14.5% of studies contained sufficient information to support replication of the measurement process. Most studies measured noise levels using a sound level meter positioned closed to a patient's bed area in an intensive care unit. CONCLUSION : Unwanted environmental noise in hospital setting impacts negatively on patient and staff health and well-being. However, this literature review found that the approaches used to objectively measure noise level in hospital settings have been inconsistent and poorly reported. Recommendations on best-practice methods to measure noise levels in hospital environments are provided.
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Affiliation(s)
- Rory Wallis
- Applied Psychoacoustics Laboratory, University of Huddersfield, Huddersfield, HD1 3DH, United Kingdom
| | - Emma Harris
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, HD1 3DH, United Kingdom
| | - Hyunkook Lee
- Applied Psychoacoustics Laboratory, University of Huddersfield, Huddersfield, HD1 3DH, United Kingdom
| | - William Davies
- Acoustics Research Centre, University of Salford, Salford, M5 4WT, United Kingdom
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, HD1 3DH, United Kingdom
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Alsulami G, Rice AM, Kidd L. Prospective repeated assessment of self-reported sleep quality and sleep disruptive factors in the intensive care unit: acceptability of daily assessment of sleep quality. BMJ Open 2019; 9:e029957. [PMID: 31227541 PMCID: PMC6596998 DOI: 10.1136/bmjopen-2019-029957] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Despite the importance of sleep, the assessment of sleep quality does not form part of standard clinical care in intensive care unit (ICU). Continuous assessment of self-reported quality of ICU patients' sleep has been strongly recommended. Prior to implementing such an assessment in the ICU, it is important to assess the acceptability of this method of assessment to the ICU's patients. The aims of this study were to assess the acceptability to ICU patients of completing daily self-reports on sleep quality during their ICU stay and to assess ICU patients' self-reported sleep quality and sleep disruptive factors during their time in ICU. METHODS An observational prospective-repeated assessment was conducted on n=120 patients in an ICU in Saudi Arabia. The participants were both intubated and non-intubated. OUTCOMES MEASURES Over a 3-month period, sleep quality was assessed using the Arabic version of the Richards-Campbell Sleep Questionnaire (RCSQ-A), and self-reported sleep disruptive factors were identified. Clinical factors, such as ICU interventions, and previously administered sedatives were also examined. The patients' acceptance of completing daily RCSQ-A reports was assessed using various indicators of acceptability. RESULTS A total of 381 self-reports (RCSQ-A) were collected for this analysis. The patients reported 34.4±5.60, indicating that sleep quality was poor on average. The group of intubated patients reported much poorer sleep quality during intubation than after extubation. In the multivariate analysis, factors which most significantly affected sleep (exp(b), p value) were midazolam (-6.424, p<0.0005), propofol (-3.600, p<0.05), noise (-1.033, p<0.05), gender (1.836, p<0.05), daytime sleepiness (0.856, p<0.05) and the presence of mechanical ventilation (-1.218, p<0.05). CONCLUSION The acceptability and feasibility of using daily RCSQ-A for sleep quality assessment was demonstrated. Sleep quality was reported as poor by all participants and the factors affecting sleep were varied. This study provided various recommendations for healthcare providers and researchers in terms of evaluating and improving sleep quality in ICU patients.
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Affiliation(s)
- Ghaida Alsulami
- Nursing, University of Glasgow School of Veterinary Medicine, Glasgow, UK
- Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ann Marie Rice
- University of Glasgow School of Medicine Dentistry and Nursing, Glasgow, UK
| | - Lisa Kidd
- School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Camuccio CA, Sanavia M, Cutrone F, Marella I, Gregio M, Cabbia C, Cocchio S, Baldo V. Noise Levels in an Acute Psychiatric Unit: An Exploratory Observational Study. Issues Ment Health Nurs 2019; 40:493-502. [PMID: 30946621 DOI: 10.1080/01612840.2018.1557301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Noise is an important aspect of the ward atmosphere climate - the combination of the architectural solutions, organizational features, the psychological traits of the operators and their interactions, and the patients' characteristics. Despite its importance noise levels have been less analyzed than other aspects of the ward atmosphere climate. Aim: In this study the aim is to identify the sources of noise and the sound pressure level in an acute psychiatric ward, and secondly to ascertain whether this is perceived by inpatients as disturbing. Method: The sound pressure levels were measured during three nonconsecutive mornings, three afternoons, and three nights. A questionnaire was administered to ascertain patients' opinions about the noise in the ward. Results: The average noise level in the ward was 62.5 dB(A)eq in the morning, 55.8 in the afternoon, and 51.5 at night. A total of 23 patients took part in the study: 65.2% of this sample did not perceive the noise in the ward as disturbing. Conclusion: In a psychiatric ward, the main source of noise is the verbal communication, and acoustic pressure also derived from care activities based around relationships. Other sources of noise perceived as disturbing came from the opening and closing of doors and the entry doorbell. Adopting relational and architectural-structural measures could reduce the sound pressure, with a view to further improving the ambience in the ward.
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Affiliation(s)
- C A Camuccio
- a Nursing School of Venice/Mestre , School of Medicine, University of Padua , Venezia/Mestre , Italy
| | - M Sanavia
- b Medical Department , Casa di Cura "Policlinico San Marco" , Venezia/Mestre , Italy
| | - F Cutrone
- c Department of Mental Health of Venice , Azienda Unità Locale Socio Sanitaria 3 Serenissima , Venezia , Italy
| | - I Marella
- d Department of Epidemiology and Environmental Hygiene , Azienda Unità Locale Socio Sanitaria 3 Serenissima , Venezia/Mestre , Italy
| | - M Gregio
- d Department of Epidemiology and Environmental Hygiene , Azienda Unità Locale Socio Sanitaria 3 Serenissima , Venezia/Mestre , Italy
| | - C Cabbia
- e Department of Cardiac, Thoracic and Vascular Sciences , School of Medicine, University of Padua , Padova , Italy
| | - S Cocchio
- e Department of Cardiac, Thoracic and Vascular Sciences , School of Medicine, University of Padua , Padova , Italy
| | - V Baldo
- e Department of Cardiac, Thoracic and Vascular Sciences , School of Medicine, University of Padua , Padova , Italy
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Better Sleep Experience for the Critically Ill: A Comprehensive Strategy for Designing Hospital Soundscapes. MULTIMODAL TECHNOLOGIES AND INTERACTION 2019. [DOI: 10.3390/mti3020036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this paper, the sleep phenomenon is considered in relation to critical care soundscapes with the intention to inform hospital management, medical device producers and policy makers regarding the complexity of the issue and possible modes of design interventions. We propose a comprehensive strategy based on soundscape design approach that facilitates a systematic way of tackling the auditory quality of critical care settings in favor of better patient sleep experience. Future research directions are presented to tackle the knowledge deficits in designing for critical care soundscapes that cater for patient sleep. The need for scientifically-informed design interventions for improving patient sleep experience in critical care is highlighted. The value of the soundscape design approach for resolving other sound-induced problems in critical care and how the approach allows for patient-centred innovation that is beyond the immediate sound issue are further discussed.
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Menear A, Elliott R, M Aitken L, Lal S, McKinley S. Repeated sleep-quality assessment and use of sleep-promoting interventions in ICU. Nurs Crit Care 2017; 22:348-354. [PMID: 29044819 DOI: 10.1111/nicc.12315] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/11/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
Abstract
To describe sleep quality using repeated subjective assessment and the ongoing use of sleep-promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep-promoting interventions has not been widely reported. An observational study was conducted in a 58-bed adult intensive care unit. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) each morning. intensive care unit audit sleep-promoting intervention data were compared to data obtained prior to the implementation of a sleep guideline. Patients answered open-ended questions about the facilitators and deterrents of their sleep in intensive care unit. The sample (n = 50) was predominately male (76%) with a mean age: 62.6±16.9 years. Sleep quality was assessed on 2 days or more for 21 patients. The majority of patients (98%) received sleep-promoting interventions. Sleep quality had not improved significantly since the guideline was first implemented. The mean Richards-Campbell Sleep Questionnaire score was 47.9±24.1 mm. The main sleep deterrents were discomfort and noise. Frequently cited facilitators were nothing (i.e. nothing helped) and analgesia. The Richards-Campbell Sleep Questionnaire was used on repeated occasions, and sleep-promoting interventions were used extensively. There was no evidence of improvement in sleep quality since the implementation of a sleep guideline. The use of the Richards-Campbell Sleep Questionnaire for the subjective self-assessment of sleep quality in intensive care unit patients and the implementation of simple-promoting interventions by intensive care unit clinicians is both feasible and may be the most practical way to assess sleep in the intensive care unit context.
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Affiliation(s)
- Ashika Menear
- Faculty of Science, University of Technology Sydney, Broadway, Australia
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Broadway, Australia.,Intensive Care Unit, Royal North Shore Hospital, St Leonards, Australia
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, Northampton Square, London, UK.,Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Australia.,Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University, Nathan, Australia
| | - Sara Lal
- Faculty of Science, University of Technology Sydney, Broadway, Australia
| | - Sharon McKinley
- Intensive Care Unit, Royal North Shore Hospital, St Leonards, NSW 2065, Australia, (in place of University of London)
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Baqar M, Arslan M, Abbasi SA, Ashraf U, Khalid A, Zahid H. Noise pollution in the hospital environment of a developing country: A case study of Lahore (Pakistan). ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 73:367-374. [PMID: 28836912 DOI: 10.1080/19338244.2017.1371106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/20/2017] [Indexed: 06/07/2023]
Abstract
The present study investigates the noise pollution levels in public- and private-sector hospitals of Lahore. The noise pollution parameters were investigated from 20 public and 10 private hospitals. We observed that the equivalent continuous sound level (Leq) values varied significantly in different departments of the hospitals as well as at different times of the day. The public-sector hospitals had significantly higher noise pollution compared to the private-sector hospitals. The Wilcoxon Mann-Whitney two-sample rank-sum test revealed significant difference between noise levels in intensive care unit (ICU) during morning and in emergency, waiting area, intensive care unit (ICU), and reception during daytimes. However, no significant differences were found for any department during the evening. The Leq values were found to be higher than the international norms (WHO standards) for all hospitals, higher than USEPA for 29 hospitals and higher than local standards for 27 hospitals. Overall, significantly lower sound levels were always observed in private hospitals.
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Affiliation(s)
- Mujtaba Baqar
- a College of Earth and Environmental Sciences , University of the Punjab , Lahore , Pakistan
- b Sustainable Development Study Centre , Government College University , Lahore , Pakistan
| | - Muhammad Arslan
- c Geosciences Department , King Fahd University of Petroleum and Minerals , Dhahran , Saudi Arabia
- d Environmental Biotechnology Department, Helmholtz Center for Environmental Research , Leipzig , Germany
| | - Saddam A Abbasi
- e Department of Mathematics, Statistics and Physics , Qatar University , Doha , Qatar
| | - Uzma Ashraf
- a College of Earth and Environmental Sciences , University of the Punjab , Lahore , Pakistan
| | - Anam Khalid
- a College of Earth and Environmental Sciences , University of the Punjab , Lahore , Pakistan
| | - Hina Zahid
- a College of Earth and Environmental Sciences , University of the Punjab , Lahore , Pakistan
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Iyendo TO. Sound as a supportive design intervention for improving health care experience in the clinical ecosystem: A qualitative study. Complement Ther Clin Pract 2017; 29:58-96. [PMID: 29122270 DOI: 10.1016/j.ctcp.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment. METHODS Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar. RESULTS Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff. CONCLUSIONS Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures.
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van de Pol I, van Iterson M, Maaskant J. Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series analysis. Intensive Crit Care Nurs 2017; 41:18-25. [DOI: 10.1016/j.iccn.2017.01.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 01/09/2017] [Accepted: 01/22/2017] [Indexed: 01/02/2023]
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Circadian disruption of ICU patients: A review of pathways, expression, and interventions. J Crit Care 2017; 38:269-277. [DOI: 10.1016/j.jcrc.2016.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 01/08/2023]
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21
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Iyendo TO. Exploring the effect of sound and music on health in hospital settings: A narrative review. Int J Nurs Stud 2016; 63:82-100. [PMID: 27611092 DOI: 10.1016/j.ijnurstu.2016.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/13/2016] [Accepted: 08/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sound in hospital space has traditionally been considered in negative terms as both intrusive and unwanted, and based mainly on sound levels. However, sound level is only one aspect of the soundscape. There is strong evidence that exploring the positive aspect of sound in a hospital context can evoke positive feelings in both patients and nurses. Music psychology studies have also shown that music intervention in health care can have a positive effect on patient's emotions and recuperating processes. In this way, hospital spaces have the potential to reduce anxiety and stress, and make patients feel comfortable and secure. This paper describes a review of the literature exploring sound perception and its effect on health care. DATA SOURCES AND REVIEW METHODS This review sorted the literature and main issues into themes concerning sound in health care spaces; sound, stress and health; positive soundscape; psychological perspective of music and emotion; music as a complementary medicine for improving health care; contradicting arguments concerning the use of music in health care; and implications for clinical practice. Using Web of Science, PubMed, Scopus, ProQuest Central, MEDLINE, and Google, a literature search on sound levels, sound sources and the impression of a soundscape was conducted. The review focused on the role and use of music on health care in clinical environments. In addition, other pertinent related materials in shaping the understanding of the field were retrieved, scanned and added into this review. RESULTS The result indicated that not all noises give a negative impression within healthcare soundscapes. Listening to soothing music was shown to reduce stress, blood pressure and post-operative trauma when compared to silence. Much of the sound conveys meaningful information that is positive for both patients and nurses, in terms of soft wind, bird twitter, and ocean sounds. CONCLUSIONS Music perception was demonstrated to bring about positive change in patient-reported outcomes such as eliciting positive emotion, and decreasing the levels of stressful conditions. Whilst sound holds both negative and positive aspects of the hospital ecosystem and may be stressful, it also possesses a soothing quality that induces positive feelings in patients. Conceptualizing the nature of sound in the hospital context as a soundscape, rather than merely noise can permit a subtler and socially useful understanding of the role of sound and music in the hospital setting, thereby creating a means for improving the hospital experience for patients and nurses.
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Affiliation(s)
- Timothy Onosahwo Iyendo
- Department of Architecture, Eastern Mediterranean University, Gazimağusa, North Cyprus, Via Mersin 10, Turkey.
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Luetz A, Weiss B, Penzel T, Fietze I, Glos M, Wernecke KD, Bluemke B, Dehn AM, Willemeit T, Finke A, Spies C. Feasibility of noise reduction by a modification in ICU environment. Physiol Meas 2016; 37:1041-55. [DOI: 10.1088/0967-3334/37/7/1041] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Kaur H, Rohlik GM, Nemergut ME, Tripathi S. Comparison of staff and family perceptions of causes of noise pollution in the Pediatric Intensive Care Unit and suggested intervention strategies. Noise Health 2016; 18:78-84. [PMID: 26960784 PMCID: PMC4918686 DOI: 10.4103/1463-1741.178480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Noise and excessive, unwanted sound in the Pediatric Intensive Care Unit (PICU) is common and has a major impact on patients' sleep and recovery. Previous research has focused mostly on absolute noise levels or included only staff as respondents to acknowledge the causes of noise and to plan for its reduction. Thus far, the suggested interventions have not ameliorated noise, and it continues to serve as a barrier to recovery. In addition to surveying PICU providers through internet-based software, patients' families were evaluated through in-person interviews utilizing a pretested instrument over 3 months. Families of patients admitted for more than 24 h were considered eligible for evaluation. Participants were asked to rank causes of noise from 1 to 8, with eight being highest, and identified potential interventions as effective or ineffective. In total, 50 families from 251 admissions and 65 staff completed the survey. Medical alarms were rated highest (mean ± standard deviation [SD], 4.9 ± 2.1 [2.8-7.0]), followed by noise from medical equipment (mean ± SD, 4.7 ± 2.1 [2.5-6.8]). This response was consistent among PICU providers and families. Suggested interventions to reduce noise included keeping a patient's room door closed, considered effective by 93% of respondents (98% of staff; 88% of families), and designated quiet times, considered effective by 82% (80% of staff; 84% of families). Keeping the patient's door closed was the most effective strategy among survey respondents. Most families and staff considered medical alarms an important contributor to noise level. Because decreasing the volume of alarms such that it cannot be heard is inappropriate, alternative strategies to alert staff of changes in vital signs should be explored.
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Affiliation(s)
- Harsheen Kaur
- Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Lange K, Nowak M, Lauer W. A human factors perspective on medical device alarms: problems with operating alarming devices and responding to device alarms. BIOMED ENG-BIOMED TE 2016; 61:147-64. [PMID: 25427057 DOI: 10.1515/bmt-2014-0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/24/2014] [Indexed: 11/15/2022]
Abstract
Medical devices emit alarms when a problem with the device or with the patient needs to be addressed by healthcare personnel. At present, problems with device alarms are frequently discussed in the literature, the main message being that patient safety is compromised because device alarms are not as effective and safe as they should - and could - be. There is a general consensus that alarm-related hazards result, to a considerable degree, from the interactions of human users with the device. The present paper addresses key aspects of human perception and cognition that may relate to both operating alarming devices and responding to device alarms. Recent publications suggested solutions to alarm-related hazards associated with usage errors based on assumptions on the causal relations between, for example, alarm management and human perception, cognition, and responding. However, although there is face validity in many of these assumptions, future research should provide objective empirical evidence in order to deepen our understanding of the actual causal relationships, and hence improve and expand the possibilities for taking appropriate action.
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Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, Jones SF. Sleep in the intensive care unit. Am J Respir Crit Care Med 2015; 191:731-8. [PMID: 25594808 DOI: 10.1164/rccm.201411-2099ci] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes. Basic and clinical research has documented the important role circadian rhythm plays in biologic function. Critical illness is a time of extreme vulnerability for patients, and the important role sleep may play in recovery for intensive care unit (ICU) patients is just beginning to be explored. This concise clinical review focuses on the current state of research examining sleep in critical illness. We discuss sleep and circadian rhythm abnormalities that occur in ICU patients and the challenges to measuring alterations in circadian rhythm in critical illness and review methods to measure sleep in the ICU, including polysomnography, actigraphy, and questionnaires. We discuss data on the impact of potentially modifiable disruptors to patient sleep, such as noise, light, and patient care activities, and report on potential methods to improve sleep in the setting of critical illness. Finally, we review the latest literature on sleep disturbances that persist or develop after critical illness.
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Affiliation(s)
- Margaret A Pisani
- 1 Department of Internal Medicine, Pulmonary, Critical Care & Sleep Division, Yale University School of Medicine, New Haven, Connecticut
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Park M, Vos P, Vlaskamp BNS, Kohlrausch A, Oldenbeuving AW. The influence of APACHE II score on the average noise level in an intensive care unit: an observational study. BMC Anesthesiol 2015; 15:42. [PMID: 25861240 PMCID: PMC4389973 DOI: 10.1186/s12871-015-0019-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/28/2015] [Indexed: 11/15/2022] Open
Abstract
Background Noise levels in hospitals, especially in intensive care units (ICUs) are known to be high, potentially affecting not only the patients’ well-being but also their clinical outcomes. In an observational study, we made a long-term measurement of noise levels in an ICU, and investigated the influence of various factors on the noise level, including the acute physiology and chronic health evaluation II (APACHE II) score. Methods The average noise level was continuously measured for three months in all (eight) patient rooms in an ICU, while the patient data were also registered, including the APACHE II score. The 24-hour trend of the noise level was obtained for the patients of length-of-stay (LOS) ≥1 day, which was compared to the timeline of the ICU routine events. For the patients with LOS ≥4 days, the average noise levels in the first four days were analyzed, and regression models were established using the stepwise search method based on the Akaike information criterion. Results Features identified in the 24-hour trends (n = 55) agreed well with the daily routine events in the ICU, where regular check-ups raised the 10-minute average noise level by 2~3 dBA from the surrounding values at night, and the staff shift changes consistently increased the noise level by 3~5 dBA. When analyzed in alignment with the patient’s admission (n=22), the daytime acoustic condition improved from Day 1 to 2, but worsened from Day 2 to 4, most likely in relation to the various phases of patient’s recovery. Regression analysis showed that the APACHE II score, room location, gender, day of week and the ICU admission type could explain more than 50 % of the variance in the daily average noise level, LAeq,24h. Where these factors were argued to have causal relations to LAeq,24h, the APACHE II score was found to be most strongly correlated: LAeq,24h increased by 1.3~1.5 dB when the APACHE II score increased by 10 points. Conclusions Patient’s initial health condition is one important factor that influences the acoustic environment in an ICU, which needs to be considered in observational and interventional studies where the noise in healthcare environments is the subject of investigation.
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Affiliation(s)
- Munhum Park
- Brain, Cognition & Perception Group, Philips Research, High Tech Campus 36, AE Eindhoven, 5656 The Netherlands
| | - Pieter Vos
- Department of Intensive Care Medicine, St. Elisabeth Hospital, P.O. Box 90151, LC Tilburg, 5000 The Netherlands
| | - Björn N S Vlaskamp
- Brain, Cognition & Perception Group, Philips Research, High Tech Campus 36, AE Eindhoven, 5656 The Netherlands
| | - Armin Kohlrausch
- Brain, Cognition & Perception Group, Philips Research, High Tech Campus 36, AE Eindhoven, 5656 The Netherlands ; Human-Technology Interaction Group, Technische Universiteit Eindhoven, P.O. Box 513, MB Eindhoven, 5600 The Netherlands
| | - Annemarie W Oldenbeuving
- Department of Intensive Care Medicine, St. Elisabeth Hospital, P.O. Box 90151, LC Tilburg, 5000 The Netherlands
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Improving the patient’s environment: the ideal intensive care unit. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mackrill J, Jennings P, Cain R. Exploring positive hospital ward soundscape interventions. APPLIED ERGONOMICS 2014; 45:1454-1460. [PMID: 24768090 DOI: 10.1016/j.apergo.2014.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 04/02/2014] [Accepted: 04/06/2014] [Indexed: 06/03/2023]
Abstract
Sound is often considered as a negative aspect of an environment that needs mitigating, particularly in hospitals. It is worthwhile however, to consider how subjective responses to hospital sounds can be made more positive. The authors identified natural sound, steady state sound and written sound source information as having the potential to do this. Listening evaluations were conducted with 24 participants who rated their emotional (Relaxation) and cognitive (Interest and Understanding) response to a variety of hospital ward soundscape clips across these three interventions. A repeated measures ANOVA revealed that the 'Relaxation' response was significantly affected (n(2) = 0.05, p = 0.001) by the interventions with natural sound producing a 10.1% more positive response. Most interestingly, written sound source information produced a 4.7% positive change in response. The authors conclude that exploring different ways to improve the sounds of a hospital offers subjective benefits that move beyond sound level reduction. This is an area for future work to focus upon in an effort to achieve more positively experienced hospital soundscapes and environments.
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Affiliation(s)
- J Mackrill
- WMG, University of Warwick, Coventry CV4 7AL, UK.
| | - P Jennings
- WMG, University of Warwick, Coventry CV4 7AL, UK
| | - R Cain
- WMG, University of Warwick, Coventry CV4 7AL, UK
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Park M, Kohlrausch A, de Bruijn W, de Jager P, Simons K. Analysis of the soundscape in an intensive care unit based on the annotation of an audio recording. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2014; 135:1875-1886. [PMID: 25234986 DOI: 10.1121/1.4868367] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The acoustic environments in hospitals, particularly in intensive care units (ICUs), are characterized by frequent high-level sound events which may negatively affect patient outcome. Many studies performed acoustic surveys, but the measurement protocol was not always reported in detail, and the scope of analysis was limited by the selected mode of sound level meters. Fewer studies systematically investigated the noise sources in ICUs by employing an observer in the patient room, which may potentially bias the measurement. In the current study, the soundscape of an ICU was evaluated where acoustic parameters were extracted from a ∼67-h audio recording, and a selected 24-h recording was annotated off-line for a source-specific analysis. The results showed that the patient-involved noise accounted for 31% of the acoustic energy and 11% of the predicted loudness peaks (PLPs). Excluding the patient-involved noise, the remaining acoustic energy was attributed to staff members (57%), alarms (30%), and the operational noise of life-supporting devices (13%). Furthermore, the contribution of each noise category to the PLPs was found to be more uneven: Staff (92%), alarms (6%), and device noise (2%). The current study suggests that most of the noise sources in ICUs may be associated with modifiable human factors.
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Affiliation(s)
- Munhum Park
- Philips Research Laboratories, High Tech Campus 36, 5656 AE Eindhoven, The Netherlands
| | - Armin Kohlrausch
- Philips Research Laboratories, High Tech Campus 36, 5656 AE Eindhoven, The Netherlands
| | - Werner de Bruijn
- Philips Research Laboratories, High Tech Campus 36, 5656 AE Eindhoven, The Netherlands
| | - Peter de Jager
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
| | - Koen Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands
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Mackrill JB, Jennings PA, Cain R. Improving the hospital 'soundscape': a framework to measure individual perceptual response to hospital sounds. ERGONOMICS 2013; 56:1687-1697. [PMID: 24073684 DOI: 10.1080/00140139.2013.835873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Work on the perception of urban soundscapes has generated a number of perceptual models which are proposed as tools to test and evaluate soundscape interventions. However, despite the excessive sound levels and noise within hospital environments, perceptual models have not been developed for these spaces. To address this, a two-stage approach was developed by the authors to create such a model. First, semantics were obtained from listening evaluations which captured the feelings of individuals from hearing hospital sounds. Then, 30 participants rated a range of sound clips representative of a ward soundscape based on these semantics. Principal component analysis extracted a two-dimensional space representing an emotional-cognitive response. The framework enables soundscape interventions to be tested which may improve the perception of these hospital environments.
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Affiliation(s)
- J B Mackrill
- a WMG, International Institute for Product and Service Innovation, University of Warwick , Coventry , CV4 7AL , UK
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Abstract
PURPOSE OF REVIEW To survey the recent medical literature reporting effects of ICU design on patients' and family members' well being, safety and functionality. RECENT FINDINGS Features of ICU design linked to the needs of patients and their family are single rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. SUMMARY An organization structured on the needs of the patient and their family is mandatory in designing a new ICU. The main aims in the design of a new department should be patient-centered care, safety, functionality, innovation and a future-proof concept.
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Schwarzkopf D, Behrend S, Skupin H, Westermann I, Riedemann NC, Pfeifer R, Günther A, Witte OW, Reinhart K, Hartog CS. Family satisfaction in the intensive care unit: a quantitative and qualitative analysis. Intensive Care Med 2013; 39:1071-9. [DOI: 10.1007/s00134-013-2862-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/27/2013] [Indexed: 01/05/2023]
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